The launch of Working for Patients . . . Cook sceptical. . . HA chairs 'delighted'. . . 'right-wing nonsense'. . .King's Fund warning

The white paper, Working for Patients , was unveiled by health secretary Kenneth Clarke. It pledges 'to keep all that is best in the NHS', while noting that the service has not 'kept pace with growing demands and rising expectations'. The government will give staff more responsibility and clearer accountability, together with 'more choice for patients'.

Shadow health secretary Robin Cook told HSJ : 'I am fairly confident that on this one Mrs Thatcher is heading for a fall.'

Health authority chairs are thought to be delighted. Many believe smaller HAs modelled on management boards will make their job easier.

British Medical Association consultants' leader Paddy Ross condemned the plans as 'right-wing nonsense', and ethics committee chair Dr Sandy Macara said: 'These proposals are made by people who know the cost of everything and the value of nothing.'

Association of Community Health Councils director Toby Harris dismissed the emphasis on patient choice as 'rhetoric', and predicted consumers would have less choice when hospitals and GPs 'opted out' under the self-governing and fundholding proposals.

Philip Hunt, director of the National Association of Health Authorities, believed the plans would lead to a more 'consumer-sensitive' service. But he wanted guarantees that comprehensive care would be available everywhere.

The Institute of Health Services Management welcomed more flexibility for managers, provided local needs were not neglected.

Quality as well as cost had to be regulated, warned the King's Fund, which feared vulnerable groups could lose out, although the paper offered 'real opportunities'. King's Fund fellow Bob Dearden cautioned managers against 'jumping too fast or burying their heads in the sand'.